Psychometric properties of Persian version of Midwives' Attitudes and Beliefs Questionnaire toward physiological childbirth

Document Type : Original Article


1 M.Sc. Student in Midwifery, Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.

2 Associate Professor, Nursing Care Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.

3 Professor, Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran.


Introduction: Since attitudes and beliefs can predict behavior, policy, and performance of an individual, so the midwives' attitudes and beliefs toward labor and delivery can also affect their caring behavior and performance, and the prenatal consequences of the mother and neonate. And the baby is effective. There was no suitable Persian tool to measure the attitude and belief of midwives toward physiological delivery, so this present study was performed with aim of translating and psychometric evaluation of the Persian version of the questionnaire of attitude and belief of midwives toward physiological delivery.
Methods: This methodological study was performed on 200 midwives working in the selected hospitals of Tehran University of Medical Sciences in 2018. The midwives were asked to complete a demographic questionnaire and midwives' attitudes and beliefs questionnaire toward physiological childbirth. At first, the face and content validity of the questionnaire was performed qualitatively. Then, construct validity was performed by confirmatory factor analysis. The reliability of the questionnaire was confirmed by stability reliability method and internal consistency.
Results: The face validity and qualitative content of the questionnaire of midwives' attitudes and beliefs toward physiological childbirth were confirmed. Also, confirmatory factor analysis by estimating weight Partial Least Squares showed that the Persian version of this questionnaire has a suitable structure. In order to determine the reliability, the Cronbach's alpha coefficient was estimated as 0.68 to 0.733 for domains of the tools and the Intra-class correlation coefficient was 0.78; both of which indicated good reliability of the Persian version of the questionnaire.
Conclusion: Persian version of the questionnaire of midwives' attitude and belief toward physiological childbirth is valid and reliable and can be used as an appropriate instrument for assessing the attitude and belief of midwives toward physiological childbirth in Iran.


  1. Miri Farahani L, Abbasi Shavazi MJ. Caesarean section change trends in Iran and some demographic factors associated with them in the past three decades. Journal of Fasa University of Medical Sciences. 2012; 2(3):127-34.
  2. Saghafi N, Pourali L, Ghanbarabadi VG, Mirzamarjani F, Mirteimouri M. Serum heat shock protein 70 in preeclampsia and normal pregnancy: A systematic review and meta-analysis. International Journal of Reproductive BioMedicine. 2018; 16(1):1.
  3. Mahfouzi Y, Kazemzadeh R. Effect of prenatal preparation classes on the duration of labor and delivery type in primiparous women. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2019;21(11):37-43.
  4. Karimi S, Kazemi F, Masoumi SZ, Shobeiri F, Roshanaei G. Effect of Consultation and Educating in Preparation Classes for Delivery on Pregnancy Consequences: A Randomized Controlled Clinical Trial. Electronic physician. 2016;8(11):3177–83.
  5. ACOG. American College of Obstetricians Gynecologists statement of policy: Out-of-hospital births in the United States 2006. Available from:
  6. Janani F, Kohan S, Taleghani F, Ghafarzadeh M. Challenges To Implementing Physiologic Birth Program (PBP): A Qualitative Study Of Midwives Opinion In Iran. Acta Medica Mediterranea. 2015;31(7):1373-80.
  7. Golshahi T. A Comparative Study Of The Midwifery Education System And The Role Of Midwives In Iran And Selected Countries In Terms Of Development In First Level Health Services (PHC). Faculty of Medical Education: Shahid Beheshti University of Medical Sciences and Health Services, School of Medical Education; 2013.
  8. Macdonald D. Exploring Collaboration Between Midwives and Nurses in Nova Scotia: A Feminist Poststructuralist Case Study: Université d'Ottawa/University of Ottawa; 2019.
  9. Vedam S, Aaker J, Stoll K. Assessing Certified Nurse‚ÄźMidwives' Attitudes Towards Planned Home Birth. The Journal of Midwifery & Women’s Health. 2010;55(2):133-42.
  10. Levine MS, Lowe NK. Measuring Nurse Attitudes About Childbirth: Revision and Pilot Testing of the Nurse Attitudes and Beliefs Questionnaire. Journal of Nursing Measurement. 2015;23(2):287-301.
  11. Hodnett ED. Pain and women's satisfaction with the experience of childbirth: a systematic review. American journal of obstetrics and gynecology. 2002;186(5):S160-S72.
  12. Moasheri BN, Sharifzadeh G, Soltanzadeh V, Khosravi Givshad Z, Rakhshany Zabol F. Relationship between fear of pain, fear of delivery and attitude towards cesarean section with preferred mode of delivery among pregnant women. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2016;18(179):8-16.
  13. Mohammadali Makhouli K, Araban M, Hassanzadeh A, Alavijeh Z. Implementation of Targeted Education to Promote Normal Vaginal Delivery: A Randomized Controlled Trial. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2018;21(10):66-74.
  14. Dunphy BC, Cantwell R, Bourke S, Fleming M, Smith B, Joseph K, et al. Cognitive elements in clinical decision-making. Advances in health sciences education. 2010;15(2): 229-50.
  15. Klein MC, Liston R, Fraser WD, Baradaran N, Hearps SJ, Tomkinson J, et al. Attitudes of the new generation of Canadian obstetricians: how do they differ from their predecessors? Birth. 2011;38(2):129-39.
  16. Klein MC, Kaczorowski J, Hall WA, Fraser W, Liston RM, Eftekhary S, et al. The attitudes of Canadian maternity care practitioners towards labour and birth: many differences but important similarities. Journal of Obstetrics and Gynaecology Canada. 2009;31(9):827-40.
  17. Liva SJ, Hall WA, Klein MC, Wong ST. Factors associated with differences in Canadian perinatal nurses’ attitudes toward birth practices. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2012;41(6):761-73.
  18. Kiani Asabiber A, Heydari M, Rahnema P, Mohammadi Tabar S. Investigation of Midwives' attitudes towards elective cesarean section and its related factors in Tehran. payesh. 2014;13(3):331-8.
  19. Heidari K, Amiri-Farahani L, Hasanpoor–Azghady SB, Ebadi A. Psychometric Properties of the Persian Version of Midwives Self-Efficacy for Labor Support Scale. Journal of Mazandaran University of Medical Sciences. 2019;29(173):107-15.
  20. Heidari M, Akbarfahimi M, Salehi M, Nabavi SM. Validity and reliability of the Persian-version of fatigue impact scale in multiple sclerosis patients in Iran. Koomesh. 2014;15(3):295-301.
  21. Grove SK, Gray JR, Faan PR. Understanding Nursing Research: First South Asia Edition, E-Book: Building an Evidence-Based Practice: Elsevier India; 2019.
  22. Hinkin TR. A review of scale development practices in the study of organizations. Journal of management. 1995;21(5):967-88.
  23. Taghizadeh Z, Ebadi A, Montazeri A, Shahvari Z, Tavousi M, Bagherzadeh R. Psychometric properties of health related measures. Part 1: Translation, development, and content and face validity. Payesh. 2017;16(3): 343 - 57.
  24. Bolarinwa OA. Principles and methods of validity and reliability testing of questionnaires used in social and health science researches. Nigerian Postgraduate Medical Journal. 2015;22(4):195-201.
  25. Almanasreh E, Moles R, Chen TF. Evaluation of methods used for estimating content validity. Research in Social and Administrative Pharmacy. 2019;15(2):214-21.
  26. MacKenzie SB, Podsakoff PM, Podsakoff NP. Construct measurement and validation procedures in MIS and behavioral research: Integrating new and existing techniques. MIS quarterly. 2011;35(2):293-334.
  27. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. Journal of clinical epidemiology. 2010;63(7):737-45.
  28. Williams B, Onsman A, Brown T. Exploratory factor analysis: A five-step guide for novices. Australasian Journal of Paramedicine. 2010;8 (3).
  29. Burns N, Grove SK. Understanding Nursing Research-eBook: Building an Evidence-Based Practice: Elsevier Health Sciences; 2010.
  30. Hair Jr JF, Hult GTM, Ringle C, Sarstedt M. A primer on partial least squares structural equation modeling (PLS-SEM): Sage publications; 2016.
  31. Tol A, Mahmoodi G, Alhani F, Shojaeezadeh D, Eslami A, Sharifirad G. Development of a valid and reliable diabetes self-management instrument: An Iranian version. Journal of Diabetes and Metabolic Disorders. 2011;10:18.
  32. Ringle CM, Sarstedt M, Straub D. A critical look at the use of PLS-SEM in MIS Quarterly. MIS Quarterly 2012;36(1).
  33. Aparicio DA. The nurses’ attitudes and beliefs questionnaire: a psychometric analysis: University of British Columbia; 2006.